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Effective June 1, 2024: Revised Payment Policy: Code Editing Overview

Date: 05/23/24

Superior HealthPlan presents a revised payment policy to incorporate existing correct coding information. As a result, the following policy has been revised and is posted on Superior’s Clinical, Payment and Pharmacy Policies webpage for review, prior to its implementation:





Code Editing Overview (TX.CC.PP.011) (PDF)





June, 1 2024






Health Insurance Marketplace (Ambetter from Superior HealthPlan); Medicare (Wellcare By Allwell HMO, HMO D-SNP)








The correct coding information listed below has been incorporated into the Code Editing Overview payment policy, to ensure provider awareness and applicability of standard coding requirements for Laboratory Services.


Diagnostic Laboratory Testing Services: Non-Covered Diagnoses

(Medicare and Marketplace ONLY)

Laboratory testing service codes billed only with a non-covered ICD-10 diagnosis will be denied, consistent with CMS National Coverage Determinations (NCDs).


Laboratory Services:  PLA and MAAA Codes

(Medicare and Marketplace ONLY)

If a Laboratory Provider has obtained an approved Proprietary Laboratory Analyses (PLA) code or the test has a Category III Multianalyte Assays with Algorithmic Analyses (MAAA code), the PLA/MAAA code must be used to bill for the service.


To review all policies, please visit Superior’s Clinical, Payment and Pharmacy Polices webpage.

For questions or additional information, please contact Superior Provider Services at:

1-877-687-1196 (Ambetter from Superior HealthPlan)